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SECTION 00456 - QUALIFICATIONS QUESTIONNAIRE <br />NOTICE: THE OWNER RETAINS THE DISCRETION TO REJECT THE BIDS OF NON - <br />RESPONSIBLE BIDDERS. <br />UNDER PENALTY OF PERJURY, the undersigned Bidder Guarantees the truth and accuracy <br />of all statements and answers herein contained. Failure to comply with these requirements <br />may be considered sufficient justification to disqualify a Bidder. Attach additional sheets as <br />required. <br />Documentation Submitted with Project No: 0946 <br />Project Name: 47th Street Roadway Improvements east of US 1 to Terminus Point. <br />1. Bidder's Name / Address: CA, :Am, µe,,r bv„e\� p 4 c_ <br />\c&c\ -d., P A '11,:, err , C'l 3(•t5 g a <br />2. Bidder's Telephone & FAX Numbers: 1.11 a.37 o • x,105 <br />E$•i\ 1)1-41 is -00\O <br />3. Licensing and Corporate Status: <br />a. Is Contractor License current? 4es <br />b. Bidder's Contractor License No: ‘kcvk t, 3 oc, [Attach a copy of Contractor's <br />License to the bid] • <br />c. Attach documentation from the State of Florida Division of Corporations that <br />indicates the business entity's status is active and that lists the names and titles of <br />all officers. <br />4. Number of years the firm has performed business as a Contractor in construction work <br />of the type involved in this contract: 43 <br />5. What is the last project OF THIS NATURE that the firm has completed? <br />d \ vv. Es�ecc-Ae . 7S7 %vgQYV rt <br />6. Has the firm ever failed to complete work awarded to you? Ur] <br />[If your answer is "yes, then attach a separate page to this questionnaire that explains <br />the circumstances and list the project name, Owner, and the Owner's telephone number <br />for each project in which the firm failed to complete the work] <br />7. Has the firm ever been assessed liquidated damages? 'k\y) <br />[If your answer is "yes, then attach a separate page to this questionnaire that explalhs <br />the circumstances and list the project name, Owner, and the Owner's telephone number <br />for each project in which liquidated damages have been assessed.] <br />8 Has the firm ever been charged by OSHA for violating any OSHA regulations? '\;a <br />[If your answer is "yes, then attach a separate page to this questionnaire that explains <br />the circumstances and list the project name, Owner, and the Owner's telephone number <br />for each project in which OSHA violations were alleged.] <br />00456 -1 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS \0946-47T11 Street (US1 to Terminus Point)Wdmim\bid documents\0946 Contract Documents \00456 - Quallficatlons <br />00456 - Qualifications Questionnaire.doc <br />